20 Gy Gamma Knife Radiosurgery For Brain Metastases = 2 Cm In Size In Or Near Eloquent Cortices: Symptom Resolution And Risk Of New Deficits

Robert Elliott1, Stephen Rush1, Amr Morsi1, Nisha Mehta1, Jeri Spriet1, Ashwatha Narayana1, Bernadine Donahue1, Erik Parker1, John Golfinos1

1NYU Langone Medical Center, New York, United States

Keywords: gamma knife, radiosurgery, brain metastasis, outcome, cortex

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     Reports of surgical resection of tumors in or near eloquent cortices have noted neurological complications in up to 30% of patients.
     We sought to analyze symptom resolution and neurological morbidity of 20 Gy gamma knife radiosurgery (GKR) for supratentorial brain metastases, 2 cm in greatest diameter.
     A retrospective analysis of 101 consecutive adults (32 males/69 females/median age 62 years) with KPS,60 who received GKR for supratentorial brain metastases, 2 cm in size was performed. 
     Lesion location was classified as eloquent, near eloquent or noneloquent as per the grading system by Sawaya (1998). Following treatment, patients underwent MRI and clinical examinations at 6 weeks and every 3 months thereafter. Four patients with 7 treated lesions who expired before 3 months following GKR were excluded to reduce underestimation of new deficits.
     Ninety-seven patients underwent 20 Gy GKR of 130 metastases at initial presentation and 31 patients had salvage 20 Gy GKR of 76 new lesions (mean/median volume: 0.29/0.19 cc). Lesions were classified as follows: eloquent—60 (29.1%), near eloquent—49 (23.8%) and noneloquent—97 (47.1%). The most common eloquent locations were precentral gyrus (21 35.6%), postcentral gyrus (15 25.4%) and calcarine (14 23.7%). Twelve patients (10-eloquent/2-near eloquent) had deficits referable to their treated lesions yielding a pre-GKR deficit rate of 5.8% per lesion and 12.4% per patient. Pre-GKR deficits improved in 7 patients (58%) at a median time of 3 months. One patient developed a new hemiparesis and 4 had worsening of pre-GKR deficits at a median of 3 months. New deficits resolved in 2 of these patients. The rates of permanent neurological deficits for lesions in or near eloquent cortices were 3.3% (2/60) and 2% (1/50), respectively. The rate of new or worsening of hemiparesis for perirolandic lesions was 5.7% (2/35). No patients with lesions in noneloquent locations had deficits prior to or following GKR.
     This is a retrospective study.
     GKR with 20 Gy provides palliation of neurological deficits from brain metastases £ 2 cm in or near eloquent cortices with low morbidity.
     Consistent with surgical literature, higher rates of neurological complications were seen as proximity to eloquent regions increased.


Project Roles:

R. Elliott (), S. Rush (), A. Morsi (), N. Mehta (), J. Spriet (), A. Narayana (), B. Donahue (), E. Parker (), J. Golfinos ()